Rapid Acquisition Of Key Concepts General Medicine

Class I

• Visualize the 
• Entire soft palate
• Uvula
• Fossces
• Anterior and posterior pillars 

Class II

• Visualize the 
• Entire soft palate
• Uvula (Partially)
• Fossces (Partially)
• Anterior and posterior pillars are not visible

Class III

• Visualize the 
• Entire soft palate
• Uvula (Base)
• Fossces, anterior and posterior pillars are not visible

Class IV

• Soft palate is invisible 

Etomidate

• Dose: 0.3 mg/kg 
• Onset of action: 10-15 sec 
• Duration: 4-10 mins 
• DOC for rapid sequence intubation
• In case of cardiogenic shock 
• Hemo neutral (No alterations in BP and HR)
• Side Effect: Decreases the glucocorticoid synthesis 
• Ketamine: Used in sepsis or septic shock 

Ketamine

• Class: Phencyclidine
• Dissociative anaesthetic
• Standard dose: 1-2 mg/kg 
• Onset of action: 45-60 secs
• Duration of action: 10-20 mins
• Preferred in case of agitation
• Has hemodynamic consequences 
• Increases the BP, HR
• Increased mean arterial pressure
• Preferred in case of shock 
• Exception: Cardiogenic shock 
• Raised ICP
• Causes bronchodilation 
• Avoid ketamine in case of normal or raised BP
• Contraindication: Patients with raised ICP 
• Avoid in cardiovascular diseases 

Midazolam

• Class: Benzodiazepines
• Dose: 0.1-0.3 mg/kg
• Has highly variable response
• Not routinely preferred 
• Onset of action: 45-90 secs
• Duration: 15-30 mins
• Produce amnestic effect
• Side effects: Dose dependent 
• Myocardial depression
• Respiratory depression 

Propofol

• Class: Alkyl phenol
• Dose: 1-3 mg/kg
• Milky white in colour
• Onset of action: 15-45 secs
• Duration: 5-10 mins
• Causes dose dependent hypotension
• Uses
• Bronchodilation: RAD 
• Status epilepticus 
• Secondary or third choice of drug
• Causes propofol infusion syndrome
• Due to its prolonged use

Thiopentone

• Class: Ultra short acting barbiturate
• Other Name: Tooth serum 
• Onset of action: <30 secs
• Duration: 5-10 mins
• Side effects
• Dose dependent hypotension
• Bronchoconstriction
• Histamine release
• Not used in RAD
• Powerful venodilators or myocardial suppression
• Precipitate acute attack of porphyria
• Uses
• Cerebroprotective
• Anticonvulsants

Endotracheal tube malposition: Reasons

Tube is in the oesophagus

• Diagnosis: Capnography
• Treatment: Reintubation

Main stem intubation or right endobronchial intubation

• Diagnosis: Clinical

• Chest X ray: Confirmation test 

• Treatment: Adjust and pull the tube (Slightly)

Cuff leak

• Diagnosis: Loss of pressure in pilot balloon 

Mucus plugging

• High peak inspiratory pressure 
• High resistance to BVM 
• Treatment: Bronchoscopy or suction

Rapid desaturation

• Inadequate preoxygenation

• Decreased time for desaturation
• Normal time: 8-10 mins 
• Patients with morbid obesity
• Restrictive lung disease
• 3rd trimester of pregnancy
• Shunt formation because FRC is very low 
• Fast intubation is recommended 

Preparation

Standard 

Preoxygenation

3 mins or 8 vital capacity breaths 

Pre-medications

-

Induction paralysis

• Etomidate:20 mg/IV 
• Succinylcholine 100 mg/IV

Positioning

• Standard sniffing 

Placement

• Direct laryngoscopy 
• Proof (Waveform capnography: ETCo2)

Post RSI management

• Regular 

Miscellaneous

-

Preparation

Standard 

Preoxygenation

3 mins or 8 vital capacity breaths 

Premedications

• Lignocaine 100 mg/IV ±
• Fentanyl 200 mcg/IV 

Induction paralysis

• Etomidate:20 mg/IV 
• Succinylcholine 100 mg/IV
• Ketamine is contraindicated

Positioning

• Standard 

Placement

• Direct laryngoscopy 
• Proof (Waveform capnography: ETCo2)

Post RSI management

• Therapeutic hyperventilation 
• PaCo2: 30-35 mmHg 
• <30: Severe hypoperfusion 

Miscellaneous

• Raised ICP care

Preparation

Standard 

Preoxygenation

3 mins or 8 vital capacity breaths 

Premedications

• Lignocaine 100 mg/IV 

Induction paralysis

• Ketamine 100mg/IV 
• Succinylcholine 100 mg/IV

Positioning

• Standard 

Placement

• Direct laryngoscopy 
• Proof (Waveform capnography: ETCo2)

Post RSI management

• Bronchodilators
• High peak inspiratory pressure: Bronchoconstriction 

Miscellaneous

-

Preparation

Standard 

Preoxygenation

3 mins or 8 vital capacity breaths 

Premedications

• Atropine 0.02 mg/kg/IV 

Induction paralysis

• Etomidate 0.3 mg/kg/IV + 
• Succinylcholine 1.5 mg/kg/IV

Positioning

• No need of sniffing 

Placement

• Standard +
• Proof (Waveform capnography: ETCo2)

Post RSI management

• Standard 

Miscellaneous

-

CPR Quality

• Rate of chest compressions should be 100-120/min
• Depth: 2 inches or 5cms
• Minimize interruptions in compressions
• Avoid excessive ventilation
• Change the compressor every 2 minutes, or 
• Sooner if fatigued
• No advanced airway: 30:2 (Compression-Ventilation ratio)
• Quantitative waveform capnography
• PETCO is low or decreasing
• Reassess CPR quality

Shock energy for defibrillation

• Biphasic
• Manufacturer recommendation (e.g., initial dose of 120-200 J)
• Unknown, use maximum available
• Second and subsequent doses should be equivalent, and 
• Higher doses may be considered
• Monophasic: 360 J

Drug therapy

• Epinephrine IV/IO dose
• 1 mg every 3-5 minutes
• Amiodarone IV/IO dose
• First dose: 300 mg bolus
• Lidocaine IV/IO dose
• First dose: 1-1.5mg/kg
• Second dose: 0.5-0.75 mg/kg

Advanced airway

• Intubate the patient and connect to the ventilator